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711 Adult Neurological Rehab > Neurological Assessment > Flashcards

Neurological Assessment Flashcards

1
Q

Sensitivity

A

Proportion of times a method correctly identifies an abnormality as being present (true positive).

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2
Q

Specificity

A

Proportion of times a method correctly identifies an abnormality as being absent (true negative).

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3
Q

Validity

A

How well the test measures what it is intended to measure. (accuracy)

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4
Q

Intra-rater reliability

A

The consistency of results obtained by a single examiner over several trials.

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5
Q

Interrater reliability

A

The consistency of results obtained by multiple examiners.

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6
Q

What is the acronym for measuring cognitive function and what does it stand for?

A

MR. CLOCK: Memory, Reasoning, Consciousness, Language, Orientation, Calculation, Knowledge

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7
Q

Receptive (Wernicke) aphasia

A

pt. has difficulty comprehending language, but can produce spoken language

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8
Q

Expressive (Broca) aphasia

A

pt. has difficulty producing spoken language, but can comprehend language

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9
Q

Lateral Corticospinal Tracts

A
  • descending
  • voluntary motor control of contralateral side
  • decussates at medulla
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10
Q

Dorsal Columns

A
  • ascending sensory

- conscious discrimative touch, pressure, vibration, and proprioception on contralateral side

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11
Q

Lateral Spinothalamic Tract

A
  • ascending sensory
  • pain and temperature
  • crosses at level in spinal cord
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12
Q

Posterior Spinocerebellar Tract

A
  • ascending sensory
  • unconscious sensory info from LE to cerebellum
  • info from muscle spindles, GTO, and joint receptors
  • no decussation
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13
Q

Posterior Spinocerebellar Tract Lesion

A

all lesions ipsilateral because it does not cross

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14
Q

Lateral Corticospinal Tract Lesions

A 
1 hemisphere:
-contralateral loss of voluntary muscle control -spasticity distally below level of lesion
-hyperactive reflexes
Internal capsule:
-contralateral spastic paralysis
-hyperactive reflexes
unilateral lesion in brainstem above decussation:
-contralateral spastic paralysis
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15
Q

Dorsal Column Lesions

A

Hemi-lesion in brainstem (above medulla):

-contralateral sensory loss

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16
Q

Lateral Spinothalamic Tract Lesion

A

unilat. lesion in postcentral gyrus:
-contralat. sensory loss
Hemi-lesion of brainstem:
-contralat. sensory loss
Hemi-lesion in SC:
-at lesion level-bilat sensory loss
-below lesion-contralat. sensory loss
Complete severance in SC:
-bilat loss of sensation of pain & temp. below level

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17
Q

Upper Motor Neuron (UMN) Lesion Location

A

Within brain and spinal cord; UMN lesions affect CNS

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18
Q

Lower Motor Neuron (LMN) Lesion Location

A

Within spinal nerve roots and peripheral nerves; LMN lesions affect PNS

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19
Q

Upper Motor Neuron (UMN) Lesion Signs

A

Signs: weakness, increased reflexes, increased tone

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20
Q

Lower Motor Neuron (LMN) Lesion Signs

A

Signs: weakness, atrophy, fasciculations, decreased reflexes, decreased tone

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21
Q

Hypotonia

A

Pathological decrease in muscle tone; little to no muscle resistance especially when stretched (i.e. Down syndrome, CP, some PNS diseases)

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22
Q

Hypertonia

A

Pathological increase in muscle tone; increased muscle resistance especially when stretched (i.e. CVA, TBI, SCI)

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23
Q

Spasticity

A

Resistance to passive motion is rate or velocity-dependent; the faster a limb is moved, the greater resistance is felt

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24
Q

Clonus

A

Rapid cycles of back-and-forth reflexes (essentially, brain does not “know how” to organize these movements)

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25
Q

Babinski’s Test/Sign

A

Tests for pathological cutaneous reflex of foot; positive if toes extend and splay when plantar aspect of foot is stroked from lateral calcaneus towards toes and medially across metatarsals

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26
Q

Hoffman’s Test/Sign

A

Tests for dysfunction of corticospinal tract especially when cervical spine is compressed; positive if thumb flexes and adducts and if fingers flex when third distal phalanx is flicked

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27
Q

Cranial Nerve Screen

A

I: Smell coffee
II: Read eye chart, check peripheral vision
III: Dilate pupils, follow penlight
IV: Look inferiorly
V: Light touch to face, jaw MMT, jaw jerk reflex
VI: Look laterally
VII: Make facial expressions, taste food
VIII: Feel and hear tuning fork, balance with eyes closed
IX/X: Check gag reflex/swallowing, practice speech
XI: Trapezius and sternocleidomastoid MMTS
XII: Stick out tongue

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28
Q

Eye Muscles and Primary Functions

A

Lateral rectus: moves eye laterally
Medial rectus: moves eye medially
Superior rectus: moves eye superiorly
Inferior rectus: moves eye inferiorly
Superior oblique: moves eye inferiorly/medially
Inferior oblique: moves eye superiorly /medially

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29
Q

Muscles Involved in Facial Expression

A

Frontalis, obicularis oculi, zygomaticus major, obicularis oris, platysma

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30
Q

Causes of Cerebellar damage

A

CVA, Head trauma, alcoholism, metastatic tumors, chemotherapy, MS

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31
Q

Global signs of cerebellar dysfunction

A

Ataxia, Tremor, Hypotonia, Dysarthria, Deviations in eye control

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32
Q

Ataxia

A

volitional movements that lack a smooth trajectory and fine motor control = uncoordinated movements

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33
Q

Intentional Tremor

A

begins & increase as limb reaches a target during volitional movement

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34
Q

Postural Tremor

A

affected by the head or trunk position

35
Q

Dysarthria

A

Poor control of word formation - unable to coordinate muscles associated with speech

36
Q

Deviations in eye control

A

Ex - nystagmus, lack of smooth pursuit, saccades, delayed initiation of eye movements

37
Q

Truncal Ataxia

A

Wide-based gait, staggering gait with variable starts and stops, lateral deviations, unequal step lengths

38
Q

Hemispheric cerebellar disorders present with changes in:

A

UE/LE muscle tone, diminished reflexes, uncoordinated voluntary movement of ipsilateral limbs, dysarthria, disequilibrium, abnormal eye movement

39
Q

If you suspect cerebellar dysfunction, perform….

A

1 UE test, 1 LE test, and 1 unsupported stance or gait test

40
Q

What are the 3 tests used to see limb coordination in cerebellum dysfunction?

A

Finger-to-nose test, Heel-Shin test, and Diadochokinesia

41
Q

Finger-to-nose test

A
  • have the patient touch your finger then back to their nose
  • time how long 5 reps take
  • Normal = smooth precise movements
42
Q

Heel-Shin test

A

pt slide heel along shin maintaining contact between heel and leg

43
Q

Dysdiadochokinesia

A

Inability to perform alternating movements of the extremities

44
Q

Upper Extremity Tests

A

Rapid Alternating Movements, finger opposition, finger-to-nose, finger-to-clinician’s finger

45
Q

Cerebellar Rebound

A

-pt sitting with arms straight out in front of them. The examiner pushes downward on both arms.
-Normal: pt’s arm will move downward toward the floor slightly without going past horizontal
Lesions: Rebounding = inability to stop motion quickly. Arm moves down toward floor then up past horizontal, and downward again before stopping

46
Q

Lower extremity tests

A

Heel to shin, toe to clinician finger, toe tapping, Standing/walking tests

47
Q

Tandem Walking

A
  • Normal: pt up to 60 y/o should be able to walk 20 steps without losing balance
  • Lesions: demonstrate loss of balance or excessive arm and trunk movements
48
Q

List and describe the 3 sensory system used in ambulation.

A
  1. Visual - light patterns, obstacles, surface changes, things in the environment, ect
  2. Somatosensory - info from skin, muscle, tendon, joint receptors relative to body parts and surface
  3. Vestibular - position and movement of head relative to gravity and inertial forces. (Peripheral - semicircular canals and otolithic organs. Central - CN VIII, vestibular nuclei, ect)
49
Q

Order of balance strategies from least to greatest.

A

Ankle, Hip, Stepping

50
Q

Static standing balance tests

A

Romberg eyes open/closed, Sharpened Romberg eyes open/closed, Single-Limb Stance eyes open/closed

51
Q

Romberg Test

A

pt stands with feet parallel and together for 30 seconds and the therapist judges the amount of sway

52
Q

Sharpened Romberg

A

pt stands with feet in tandem for 30 seconds and the therapist judges the amount of sway

53
Q

Anterior Spinocerebellar Tract

A

Carries unconscious sensory info from LE muscle spindles, golgi tendon organs, and joint receptors to cerebellum
Decussates in lumbar spinal cord

54
Q

Anterior Spinocerebellar Tract lesions

A

1 hemisphere lesion= contralateral proprioceptive loss
Superior cerebellar peduncle lesion= contralateral proprioceptive loss
Hemi-lesion in spinal cord at lesion level= bilateral proprioception loss
Hemi-lesion in spinal cord below lesion= contralateral proprioception loss
Complete SC severance= bilateral LE proprioception loss

55
Q

Descending Vestibulospinal Tracts

A

Facilitates extensor tone, antigravity (extensor) muscles, and postural muscles
DOES NOT DECUSSATE

56
Q

Vestibulospinal Tract Damage

A 
Decerebrate rigidity (spastic extension of both UE and LE)
Much poorer prognosis than decorticate
57
Q

Nerve root compression

A

Causes dermatomal sensation loss

Can be due to: narrowing of vertebral foramen, facet hypertrophy, herniated disc

58
Q

Peripheral Nerve Injury

A

Presentation: non-dermatomal pattern

Caused by: local compression, crush injury, surgical incision

59
Q

SCI

A

Typically damages several or all ascending and descending nerve tracts
Varied somatosensory and motor dysfunction from minor to complete

60
Q

Tumor

A

Affects somatosensory and motor tracts depending upon location

61
Q

Brain lesions

A

Result of CVA, TBI, or tumor
Affects somatosensory and motor function if in thalamus and parietal lobe
Presentation: unilateral somatosensory deficits opposite lesion unless both hemispheres of brain involved

62
Q

Nonselective Nerve Damage

A

Bilateral and symmetrical somatosensory loss that does not follow and known nerve pathway
Stocking glove distribution varying from minor to extensive loss

63
Q

Diabetes Mellitus

A

Body fails to produce or adequately use insulin

64
Q

MS

A

Progressive autoimmune disease that demyelinates CNS axons
Slows/blocks motor and sensory paths
Numbness and tingling= 1st signs and symptoms

65
Q

Guillain-Barre Syndrome

A

Non-progressive autoimmune disease affecting myelination of PNS axons
Slows/blocks neural connection in sensory or motor paths

66
Q

Hansen’s Disease

A

Chronic bacterial infection (leprosy)
Primarily affects peripheral nerves
1st sign in 90%= numbness in distal extremities

67
Q

Lyme Disease

A

Inflammatory disease caused by dear tick bite

Loss of sensation in arms and legs can develop rapidly

68
Q

Alcoholic Neuropathy

A

Sensory loss appears first in stocking and glove pattern as result of axonal degradation
Differential diagnosis difficult due to denial

69
Q

Somatosensory Screening

A

Inform pt of purpose and how it will go
Compare bilaterally and distal to proximal
Vary pace and attempt to map areas of loss

70
Q

Light Touch testing

A

Tests dorsal columns (Spinothalamic crude touch)

Use cotton, gauze, or finger and gently rub over skin

71
Q

Protective sensation

A

Tests Spinothalamic and Dorsal columns

Use monofilaments

72
Q

Sharp/Dull Pain

A

Tests Spinothalamic Tract

Use safety pin or something sharp and poke them throughout dermatomes

73
Q

Vibration

A

Tests dorsal columns
Use tuning fork and touch to skin in various areas throughout extremity
Have pt tell you when they can no longer feel vibration (should be 30-60 sec)

74
Q

Temperature

A

Tests Spinothalamic tract
Can be omitted if pain sensation is intact
Use 2 tuning forks or test tubes with one hot and one cold and apply to different areas
Have pt tell you which side and whether it is hot or cold

75
Q

Position Sense

A

Tests dorsal columns

Use minimal stabilization and have pt close eyes and tell you if joint/limb is in up or down position

76
Q

Joint Space Test (Contralateral Mirroring)

A

Have pt close eyes and put uninvolved limb into a position, then have patient copy position with involved limb
Not useful if pt has bilateral involvement

77
Q

Finger-to-Nose Test

A

Ask pt to close eyes and lightly touch one finger, then have pt take that finger and touch their nose

78
Q

Discriminative sensation

A

Tests dorsal columns and portions of cerebral cortex

Combination of stereognosis, graphesthesia, 2-point discrimination, and point localization

79
Q

Stereognosis

A

Have pt close eyes and hand them common items and identify what item they are holding

80
Q

Graphesthesia

A

Use blunt end of pen or finger and write letters/numbers on pt skin and have them identify what letter or number it was

81
Q

2-point discrimination

A

Use tool and touch pt finger simultaneously with distance getting closer and closer
Normal= 5mm on finger pads

82
Q

Point Localization

A

Have pt close eyes, lightly touch skin, have pt open eyes and point to where you touched
Repeat on both sides and throughout body

83
Q

When to Test

A

If pt C/o Sx consistent with neuro involvement, start with light touch and pain, then move to other portions of exam if normal
If ABNORMAL, do more neuro testing
Always perform light touch
No need to test further if no deficits or if pt has condition that would not affect nervous system

711 Adult Neurological Rehab (12 decks)

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